Medical Policies

Coverage for services under Medicare is primarily established through the Social Security Act. Provisions of the Social Security Act are applied to specific services based on various regulations, National Coverage Determinations established by the Centers for Medicare & Medicaid Services (CMS), various CMS guidelines, and Local Coverage Determinations (LCDs) established by CGS.

  • NCDs are developed by CMS to describe the circumstances for Medicare coverage nationwide for an item or service.
  • LCDs are developed by Medicare Administrative Contractors (MACs), including CGS, and indicate whether a particular item or service is covered in accordance with the Social Security Act, section 1862(a)(1)(A).
  • NCDs and LCDs only address certain services and items; in other words, not every item or service has a corresponding NCD or LCD. In these cases, the Social Security Act, and in some cases, additional guidance published by CMS, establish the basis for coverage.
  • For more information about NCDs, LCDs, and other coverage provisions, refer to the CMS Medicare Program Integrity Manual (Pub. 100-08), chapter 13External PDF.

IMPORTANT NOTE: CGS does NOT house LCDs on our website. By following the links below you will be sent directly to the CMS LCD database.

CGS has updated all current ICD-9 LCDs in the Medicare Coverage Database to their translated ICD-10 version. Because of this change, all LCDs and related articles have new numbers in the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database. Although these documents have new numbers, no changes were made to the policies, articles, or associated documents concerning CGS policies.

Looking for LCDs Converted to ICD-10?

The following links provide access to the list of Kentucky and Ohio Part A converted ICD-10 Local Coverage Determinations (LCDs), and the Medicare Learning Network Matters® article, SE1421.

CMS also provides the LCD Contractor IndexExternal Website, where providers can browse LCDs by contractor.

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